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Re-irradiation for recurrent glioma: outcome evaluation, toxicity and prognostic factors assessment. A multicenter study of the Radiation Oncology Italian Association (AIRO)

  • Pierina Navarria
  • Giuseppe Minniti
  • Elena Clerici
  • Stefano Tomatis
  • Valentina Pinzi
  • Patrizia Ciammella
  • Marco Galaverni
  • Dante Amelio
  • Daniele Scartoni
  • Silvia Scoccianti
  • Marco Krengli
  • Laura Masini
  • Lorena Draghini
  • Ernesto Maranzano
  • Valentina Borzillo
  • Paolo Muto
  • Fabio Ferrarese
  • Laura Fariselli
  • Lorenzo Livi
  • Francesco Pasqualetti
  • Alba Fiorentino
  • Filippo Alongi
  • Michela Buglione di Monale
  • Stefano Magrini
  • Marta Scorsetti
Clinical Study

Abstract

Introduction

The prognosis of glioma is dismal, and almost all patients relapsed. At recurrence time, several treatment options are considered, but to date there is no a standard of care. The Neurooncology Study Group of the Italian Association of Radiation Oncology (AIRO) collected clinical data regarding a large series of recurrent glioma patients who underwent re-irradiation (re-RT) in Italy.

Methods

Data regarding 300 recurrent glioma patients treated from May 2002 to November 2017, were analyzed. All patients underwent re-RT. Surgical resection, followed by re-RT with concomitant and adjuvant chemotherapy was performed. Clinical outcome was evaluated by neurological examination and brain MRI performed, 1 month after radiation therapy and then every 3 months.

Results

Re-irradiation was performed at a median interval time (IT) of 16 months from the first RT. Surgical resection before re-RT was performed in 19% of patients, concomitant temozolomide (TMZ) in 16.3%, and maintenance chemotherapy in 29%. Total doses ranged from 9 Gy to 52.5 Gy, with a median biological effective dose of 43 Gy. The median, 1, 2 year OS were 9.7 months, 41% and 17.7%. Low grade glioma histology (p  ≪ 0.01), IT > 12 months (p = 0.001), KPS > 70 (p = 0.004), younger age (p = 0.001), high total doses delivered (p = 0.04), and combined treatment performed (p = 0.0008) were recorded as conditioning survival.

Conclusion

our data underline re-RT as a safe and feasible treatment with limited rate of toxicity, and a combined ones as a better option for selected patients. The identification of a BED threshold able to obtain a greater benefit on OS, can help in designing future prospective studies.

Keywords

Recurrent glioma Re-irradiation Prognostic factors 

Notes

Author contribution

All authors have read and approved the present form of manuscript.

Compliance with ethical standards

Conflict of interest

There are no conflict of interest disclosures from any authors.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Research involving human and animal participants

This article does not contain any studies with animals performed by any of the authors.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Pierina Navarria
    • 1
  • Giuseppe Minniti
    • 2
  • Elena Clerici
    • 1
  • Stefano Tomatis
    • 1
  • Valentina Pinzi
    • 3
  • Patrizia Ciammella
    • 4
  • Marco Galaverni
    • 4
  • Dante Amelio
    • 5
  • Daniele Scartoni
    • 5
  • Silvia Scoccianti
    • 6
  • Marco Krengli
    • 7
  • Laura Masini
    • 7
  • Lorena Draghini
    • 8
  • Ernesto Maranzano
    • 8
  • Valentina Borzillo
    • 9
  • Paolo Muto
    • 9
  • Fabio Ferrarese
    • 10
  • Laura Fariselli
    • 3
  • Lorenzo Livi
    • 6
  • Francesco Pasqualetti
    • 11
  • Alba Fiorentino
    • 12
  • Filippo Alongi
    • 12
  • Michela Buglione di Monale
    • 13
  • Stefano Magrini
    • 13
  • Marta Scorsetti
    • 1
    • 14
  1. 1.Radiotherapy and Radiosurgery DepartmentHumanitas Cancer Center and Research HospitalMilanItaly
  2. 2.Advanced Radiotherapy CenterUPMC San Pietro FBFRomaItaly
  3. 3.Radiotherapy UnitIstituto Neurologico Fondazione “Carlo Besta”MilanItaly
  4. 4.Radiation Therapy Unit, Department of Oncology and Advanced TechnologyAzienda Ospedaliera Arcispedale S Maria NuovaReggio EmiliaItaly
  5. 5.Proton Therapy CenterAzienda Provinciale per I Servizi Sanitari (APSS)TrentoItaly
  6. 6.Radiation Oncology UnitAzienda Ospedaliera Universitaria CareggiFlorenceItaly
  7. 7.Radiotherapy Unit, Department of Translation MedicineUniversity of Piemonte OrientaleNovaraItaly
  8. 8.Radiotherapy Oncology Centre“S. Maria” HospitalTerniItaly
  9. 9.UOC Radiation OncologyIstituto Nazionale per lo Studio e la Cura dei Tumori -Fondazione “Giovanni Pascale”NaplesItaly
  10. 10.Radiation TherapyOspedale Ca’ Foncello di TrevisoTrevisoItaly
  11. 11.Radiation OncologyAzienda Ospedaliera Universitaria PisanaPisaItaly
  12. 12.Radiation OncologySacro Cuore Don Calabria HospitalNegrar-VeronaItaly
  13. 13.Department of Radiation OncologyUniversity and Spedali Civili HospitalBresciaItaly
  14. 14.Department of Biomedical SciencesHumanitas UniversityMilanItaly

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